THE ROLE OF RADIATION THERAPY IN BREAST CANCER

Objectives Your cancer therapy “Journey” Why Radiation? Step by Step Side Effects Follow Up

The Patient’s Journey After a positive diagnosis of cancer is made, the patient is referred to the Cancer Centre The patient receives a letter in the mail for a New Patient Appointment: Extensive history and physical done by nurse and doctor

The Patient’s Journey The patient is then referred to the Multidisciplinary Breast Clinic. Team Approach -each case is discussed in rounds prior to each discipline meeting with the patient The best course of treatment for each patient is decided

Multidisciplinary Breast Clinic: A Team Approach Includes: Radiation Oncology Medical Oncology Surgery Pathology Supportive Care Social Worker Dietician Genetics Nurse

Radiation Therapy Many Reasons Breast Conserving Surgery Reduces the need for Mastectomy May be used in very large tumours Making surgery easier Reduces the risk of recurrence In Patients with Mastectomy

Why Radiation Therapy? Uses high energy x-rays to destroy microscopic disease that may be left behind after surgery and/or chemo REDUCES THE RISK OF LOCAL RECURRENCE

Radiation Therapy after Mastectomy Depends on several factors: Number of lymph nodes involved Tumour size and characteristics Margin status after surgery

A Patient’s Journey Through the Radiation Therapy Department

Radiation Therapy Department

1. Simulation Appointment Patient education by RT CT Scan done treatment position Reference marks (Tattoos) Time 1 hour

CT SIMULATION

2. Target Definition Done on computer Critical structures outlined on CT images by radiation therapist - spinal cord, lung, heart Radiation Oncologist places radiation beams to cover the treatment area

Critical Structures and Target Definition

3. Treatment Planning Info sent electronically planning department Custom radiation treatment plan Complex Takes up to 2 weeks

Treatment Plan

Treatment Plan

Treatment Plan

4. Dry Run on Treatment Unit Patient set-up using reference tattoos put on at time of simulation Measurements verified X-ray pictures (check films) taken of all treatment fields

Linear Accelerator

World Leader

X-Ray Pictures taken on Treatment Machine Careful QA process

5. Treatment Begins Standard: up to 25 treatments Takes ~ 15 min total Daily, Monday-Friday Takes ~ 15 min total set-up 5-10 minutes radiation on ~ 3 minutes

Treatment Patients are alone in room Patients closely monitored During treatment Reduce life time exposure to Staff Patients closely monitored Video camera Intercom

Treatment Do not see or feel anything NOT radioactive

Acute Side Effects Begin after 2-3 weeks Skin Reaction Swelling Pain Not everyone reacts the same All side effects are in the treated area Continue after treatment is complete. Skin Reaction Swelling Pain Fatigue

SKIN REACTION Often worse in areas of friction Under breast In axilla

SKIN REACTION Erythema Dry Desquamation Moist Desquamation

6 weeks following left breast

6 weeks following right breast

SKIN REACTION ADVICE Gentle washing with mild soap Unscented creams Dove, Baby soap Unscented creams Lubriderm, Glaxal Base Hydrocortisone cream Allow air to get at the area Loose, comfortable clothing Avoid sun exposure Deodorant – OK unless skin irritated Use electric razor if shaving underarm

SWELLING Breast may Irritation / pain in area of scar Advice: swell slightly become tender Irritation / pain in area of scar Advice: Tylenol, Advil or Tylenol #3 NO heating pads / ice packs

FATIGUE Usually mild Light exercise and fresh air Frequent rests Worse in patients w/ chemo Light exercise and fresh air Frequent rests Well balanced diet Stress management techniques Fatigue booklet & video available

Assessment Daily – Radiation Therapist Weekly Urgent Appointments Radiation Oncologist Nurse Urgent Appointments if necessary

Late Toxicities Hypo / hyper-pigmentation skin Telangiectasia Lymphedema Radiation Pneumonitis (<2% risk) Costochondritis Heart toxicity –left side

FOLLOW UP Appointments with Oncologist: Every 3 months for years 1-2 Annually

FOLLOW UP Annual bilateral mammogram Physical Exam Other follow up tests -Blood work -X-Ray -CT scan -Ultrasound

QUESTIONS?